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by Maureen Salamon

Doctors Urge Meningitis Shots for Vulnerable Infants, Children

And teens, college students should make sure their vaccines are up to date, says Academy of Pediatrics
MONDAY, July 28, 2014 (HealthDay News) -- Infants and children who are at risk of contracting meningitis because of specific health problems should be vaccinated against the infection, according to updated recommendations from the largest pediatrician group in the United States.
And routine vaccinations for the potentially deadly infection should continue for adolescents and college students, the American Academy of Pediatrics says.
In its first statement on meningococcal vaccines since 2011, the academy notes that three such vaccines are now licensed for use down into infancy. They are deemed appropriate for youngsters age 2 months and older with immune deficiencies, missing spleens, sickle cell disease or other higher infection risks. Other young children don't need the shots, the guidelines say.
Those same meningococcal vaccines and boosters, long recommended for children 11 and older, should continue to be given to those kids, the academy stated.
"We needed to have new recommendations so that pediatricians would understand how to use these vaccines in young infants and children, since they're now available," said guidelines author Dr. Michael Brady, associate medical director at Nationwide Children's Hospital in Columbus, Ohio.
"We're telling pediatricians that we don't feel it's necessary to give this vaccination routinely to young children," he added, "but for children with select risks, it's a good vaccine to give."
The updated meningococcal recommendations are published online July 28 in the journal Pediatrics.
Meningococcal disease is linked to a variety of infections, including meningitis and pneumonia. Meningitis, an infection of the covering of the brain and spinal cord, strikes between 800 and 1,200 people in the United States each year, according to the National Meningitis Association.
Up to 15 percent of those affected die, while about one in five who survive ends up with permanent disabilities such as brain damage, hearing loss or limb amputations.
Typically, otherwise healthy children younger than 11 who develop meningitis have contracted the "B" strain. A vaccination for this type has not yet been approved by the U.S. Food and Drug Administration, which is why that age group is not routinely immunized, Brady said. There are five strains of bacterial meningitis and each tends to strike a specific age group or population, according to background information in the study.
The "B" strain of bacterial meningitis is what sickened a small group of college students at Princeton University in New Jersey earlier this year and killed a student from Drexel University in Philadelphia who had been in close contact with Princeton students.
But immune-compromised children, along with those who will travel to the "meningitis belt" in sub-Saharan Africa or participate in the Hajj pilgrimage to Mecca, should now be immunized with available vaccines, which target meningitis strains more common among adolescents and college students, he said.
Additionally, the updated recommendations said booster doses should be given after three years in high-risk children whose last dose was before age 7, while booster doses should be administered after five years in children whose last dose was at age 7 or older.
Brady noted that the meningitis outbreaks on college campuses over the last year from the "B" strain are not unexpected, since conditions are ripe for the disease to be transmitted among those living communally in dorms or military barracks. Higher rates of smoking and alcohol consumption are also associated with greater risks of contracting meningitis.
A meningitis "B" vaccine licensed in other countries was provided to students at Princeton through an emergency process, Brady noted. The academy's recommendations for a "B" vaccine await FDA approval, possibly next year, he said.
Dr. Melissa Stockwell, a pediatrician at New York-Presbyterian/Columbia's Morgan Stanley Children's Hospital, said parents should know that meningococcal vaccinations are the best way to prevent the infection.
While parents don't need to understand all the subtypes of meningitis, she said, they should consult their child's pediatrician to make sure all appropriate immunizations are administered.
"For adolescents, young adults and the younger ones with special [vulnerabilities] -- we want to make sure if you're one of these groups, you're vaccinated," said Stockwell.
More information
The U.S. National Library of Medicine offers more on meningitis (http://www.nlm.nih.gov/medlineplus/ency/article/000680.htm ).
SOURCES: Michael Brady, M.D., associate medical director, Nationwide Children's Hospital, Columbus, Ohio; Melissa Stockwell, M.D., M.P.H., pediatrician, New York-Presbyterian/Columbia's Morgan Stanley Children's Hospital, and assistant professor, pediatrics, and population and family health, Columbia University Medical Center, New York City; August 2014 Pediatrics
by Maureen Salamon

Health Highlights: July 28, 2014

Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:
2 Americans Working in Liberia Are Infected With Ebola
Two Americans working to help Ebola victims in the West African country of Liberia have themselves become infected, an aid organization said.
According to the Associated Press, Dr Kent Brantly, 33, has tested positive for the highly contagious, often fatal viral disease and is currently being treated in a hospital in Monrovia, Liberia. The North Carolina-based aid agency Samaritan's Purse announced his illness in a news release issued Saturday, the AP said.
Brantly, who previously worked at a family practice in Fort Worth, Texas, has been working in Liberia since October of 2013 and is the medical director for Samaritan's Purse's case management center in Monrovia.
The second American stricken with Ebola is Nancy Writebol, a worker with a group called SIM (Serving in Mission) that is allied with Samaritan's Purse. She had been working as a hygienist focused on decontaminating people who entered and left the Monrovia Ebola care center, AP said.
Both Brantly and Writebol are in "stable and serious" condition, Samaritan's Purse vice-president Ken Isaacs told the AP Sunday.
Group spokeswoman Melissa Strickland said that Brantly's wife and children had been living with him in Africa but are currently back in the United States. They left last week, before Brantly began to feel ill. "They have absolutely shown no symptoms," she said.
The Ebola outbreak has killed more than 670 people across several West African nations so far this year, the AP said.
by Maureen Salamon

Preemies May Have Higher Risk of Blood Clots, Even as Adults

Odds are small, but family, doctors should keep possibility in mind, researchers say
MONDAY, July 28, 2014 (HealthDay News) -- Babies born prematurely appear to have a slightly increased risk of potentially fatal blood clots that they will carry into adulthood, Swedish researchers report.
Doctors have previously suspected that babies born earlier than 37 weeks' gestation have a raised risk of deep vein thrombosis and pulmonary embolism, two serious conditions caused by blood clotting in the veins, the researchers noted in background information.
This new study confirms that link, and takes it even further. Premature birth appears to be linked to an increased chance of blood clots in the veins in childhood and early adulthood, according to findings published online July 28 in the journal Pediatrics.
The researchers also reported that a baby's chances of blood clot-related illnesses are directly related to the degree of prematurity. "The more premature, the higher the risk," said Dr. Edward McCabe, chief medical officer of the March of Dimes. A full-term pregnancy lasts from 39 to 40 weeks.
While parents and doctors should keep this risk in mind, they should also be aware that the risk is not huge, said Dr. Kristi Watterberg, chair of the American Academy of Pediatrics' committee on the fetus and newborn. Watterberg and McCabe were not involved with the study.
The association between premature birth and clot risk seen in the study does not prove a cause-and-effect relationship.
The study involved 3.5 million babies born in Sweden between 1973 and 2008, including almost 207,000 born preterm. Out of all the births, only about 7,500 children -- 0.2 percent -- suffered either deep vein thrombosis or pulmonary embolism later in life.
"I think it's important scientifically to know, but it's such a low incidence phenomenon that there are a lot of things to think about before that," said Watterberg, a professor of pediatrics and neonatology at the University of New Mexico School of Medicine.
Deep vein thrombosis involves blood clots that form in a vein deep in the body. If these clots aren't treated and dissolved, they can break off and travel through the bloodstream to the lungs, causing a blockage called a pulmonary embolism. Such a blockage can be deadly.
For the study, Dr. Bengt Zoller, of the Center for Primary Health Care Research at Lund University in Malmo, Sweden, and colleagues used records from the Swedish Birth Registry to track the babies' health. The researchers found that premature babies had an increased risk of blood clots in their veins in infancy, but also from ages 1 to 5 and from 18 to 38.
Very preterm births -- before 34 weeks of gestation -- also had a risk of blood clot-related illness in adolescence, from age 13 to 17.
Boys had an increased risk of blood clots in infancy, while girls were more likely to carry the risk into adolescence and adulthood, the study authors reported.
No one knows why this increased risk exists, but it could be due to genetic factors that caused the mother to deliver prematurely in the first place, Watterberg and McCabe said.
Diseases such as diabetes, thyroid problems and obesity are genetic in nature and can cause preterm delivery, McCabe said.
Also, some mothers who suffer a genetic deficiency in a key protein that controls blood clotting may be predisposed to give birth prematurely, Watterberg said.
"It may be that maternal genetics are a setup for preterm delivery, and those problems are passed along to the infant," she said.
The mother's wellness and lifestyle also play a role in a baby's lifelong health, and could influence their risk of blood clots, McCabe said.
Finally, this link might arise because the babies are born prematurely, and are robbed of maternal hormones and nutrition in the womb that could have decreased their future risk of blood clots.
"We are not as good at getting nutrition into those babies as the mother and placenta are, and we do know that hormones have something to do with the predisposition to clotting," Watterberg said. "It makes sense to me you'd have changes in those long-term outcomes as well."
In any case, it is something for the family and doctor of a person born prematurely to keep in mind, McCabe said.
"If a patient has a history of preterm birth, and the more preterm, the more attention it needs to have," he said. "It helps us be better prepared. If a patient comes in with unusual findings, this provides us some clue."
More information
For more on deep vein thrombosis and pulmonary embolism, visit the U.S. Centers for Disease Control and Prevention (http://www.cdc.gov/ncbddd/dvt/index.html ).
SOURCES: Edward McCabe, M.D., Ph.D., chief medical officer, March of Dimes; Kristi Watterberg, M.D., chair, American Academy of Pediatrics' Committee on the Fetus and Newborn, and professor, pediatrics and neonatology, University of New Mexico School of Medicine; August 2014, Pediatrics
by Maureen Salamon

Tonsillectomy for Sleep Apnea May Trigger Weight Gain

Study found overweight kids who had surgery were more likely to become obese within seven months
MONDAY, July 28, 2014 (HealthDay News) -- Tonsillectomies are commonly done to relieve sleep apnea in children, but a new study confirms that the treatment can speed kids' weight gain -- especially if they're already overweight.
The researchers said that's a concern, because obesity is a risk factor for a range of health problems -- including, ironically, sleep apnea. But they're not advising against tonsillectomy for kids who need it.
Instead, they said, doctors and parents should be aware that a healthy diet and exercise become even more important after children have the surgery.
"You can't just treat the sleep apnea. You have to have nutrition and lifestyle counseling, too," said lead researcher Dr. Eliot Katz, a respiratory disease specialist at Boston Children's Hospital.
A pediatric sleep specialist who was not involved in the study agreed.
"Nutrition and exercise are just as important as treating the sleep apnea with a single procedure," said Dr. Sangeeta Chakravorty, who co-directs the pediatric sleep evaluation center at Children's Hospital of Pittsburgh.
Obstructive sleep apnea arises when constriction in the airways causes repeated pauses in breathing during the night. In children, the most common cause is swelling in the tonsils and adenoids -- infection-fighting tissues in the back of the throat and the nasal cavity, respectively. And surgery to remove those tissues (known technically as adenotonsillectomy) is often recommended.
Doctors have long known that after the surgery, kids can gain weight at an accelerated clip, Chakravorty said.
But the new study, reported online July 28 and in the August print issue of the journal Pediatrics, offers "certainty" that it's actually an effect of the treatment, Katz said.
That's because children in the study were randomly assigned to have surgery or to "watchful waiting" -- putting off surgery and staying with other options, such as medications to better control any nasal allergies or asthma symptoms.
Altogether, 204 children aged 5 to 9 were assigned to have surgery right away, while 192 stuck with watchful waiting. Katz's team found that over seven months, children who underwent surgery showed a quicker average weight gain, versus kids in the comparison group.
It was a small difference overall, Chakravorty said. And for children who were normal weight, there was no major effect.
"It's not making normal-weight children obese," Chakravorty noted.
But there was a clearer impact on kids who were overweight before surgery. Of those children, 52 percent had become officially obese seven months after surgery, compared with 21 percent of overweight children in the watchful-waiting group, the study found.
There are a few possible explanations for the post-surgery weight gain, according to Katz's team. Calorie-burning may dip when children are no longer laboring to breathe during sleep. And some kids may burn fewer calories during the day because they become less active after their sleep apnea improves. (Paradoxically, poor sleep often causes children to be "hyperactive," rather than drowsy, Katz explained.)
Sleep apnea itself also causes metabolic changes, Katz said. Growth hormone is released at night, and the sleep disorder can interfere with that. So the body may adapt metabolism in an effort to maintain a child's growth.
"When the sleep apnea is relieved, they're set up for rapid weight gain," Katz said.
It was once common for children with sleep apnea to be underweight and have "failure to thrive," Chakravorty noted. For those kids, rapid weight gain after tonsillectomy can be a good thing.
But these days, with childhood obesity on the rise, many kids with sleep apnea are already overweight or obese. If they rapidly put on pounds, Katz said, their sleep apnea might return in six months to a year.
"After surgery, parents are often very satisfied," Katz noted. "Their kids are sleeping better, and they may be better behaved and doing better in school. But there's this insidious issue of weight gain."
Chakravorty agreed that diet and exercise are key for children with sleep apnea -- but she said that's true regardless of the treatment approach. And, for heavy kids, weight loss alone might clear up the sleep apnea.
But if children ultimately do need surgery, parents shouldn't skip it due to worries about weight gain, according to Katz. He noted that if improved sleep apnea symptoms explain the post-surgery pounds, then other treatments -- including medication or continuous positive airway pressure devices -- could also spur excess weight gain.
"I think there are implications beyond surgical treatment," Katz said.
More information
The American Sleep Apnea Association has more on treatment for children. (http://www.sleepapnea.org/treat/childrens-sleep-apnea.html )
SOURCES: Eliot Katz, M.D., pulmonary and respiratory diseases, Boston Children's Hospital; Sangeeta Chakravorty, M.D., co-director, pediatric sleep evaluation center, Children's Hospital of Pittsburgh; August 2014, Pediatrics
by Maureen Salamon

Health Highlights: July 27, 2014

Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:
U.S. Doctor Working in Liberia Is Infected With Ebola
An American physician who was helping Ebola victims in the West African country of Liberia has himself become infected, the aid organization he was working with said on Saturday.
According to the Associated Press, Dr Kent Brantly, 33, has tested positive for the highly contagious, often fatal viral disease and is currently being treated in a hospital in Monrovia, Liberia. The North Carolina-based aid agency Samaritan's Purse announced his illness in a news release issued Saturday, the AP said.
Brantly, who previously worked at a family practice in Fort Worth, Texas, has been working in Liberia since October of 2013 and is the medical director for Samaritan's Purse's case management center in Monrovia.
Group spokeswoman Melissa Strixkland said that Brantly's wife and children had been living with him in Africa but they are currently back in the United States.
The Ebola outbreak has killed 672 people in several West African nations so far this year, the AP said.
by Maureen Salamon

Wives' Higher Education May Not Affect Divorce Rate

Couples with equal levels of academic achievement less likely to split than if husbands have more, study finds
SUNDAY, July 27, 2014 (HealthDay News) -- Couples aren't more likely to get divorced if the wife has more education than the husband, new research finds.
The study only looks at trends in marriage, it doesn't prove that education levels play a direct role in affecting whether couples stay together or get divorced.
Still, "our results speak against fears that women's growing educational advantage over men has had negative effects on marital stability," Christine Schwartz, lead author of the study, said in an American Sociological Association news release.
"Further, the findings provide an important counterpoint to claims that progress toward gender equality in heterosexual relationships has stalled," said Schwartz, who is an associate professor of sociology at the University of Wisconsin-Madison.
The study also found that "couples in which both individuals have equal levels of education are now less likely to divorce than those in which husbands have more education than their wives," Schwartz said.
"These trends are consistent with a shift away from a breadwinner-homemaker model of marriage toward a more egalitarian model of marriage in which women's status is less threatening to men's gender identity," she noted.
The research focuses on heterosexual marriages in the United States from 1950 to 2009. Women began to finish college at higher levels than men in the 1980s, according to the study. Since that time, the wife has more education in a growing percentage of couples.
"Rather than doggedly adhering to norms that wives should have lower status than their husbands, men and women are increasingly forming relationships in which women have the educational advantage -- so much so that it is now more common for wives to have more education than their husbands than the reverse pattern," Schwartz said.
"The relationship between one's educational attainment, marriage formation, and risk of divorce appears to suggest that couples are adapting to the demographic reality that women have more education than men," she noted.
Couples married in the 1950s were just as likely to divorce whether the husband and wife had the same level of education or the husband had more. But more recently, married couples were one-third less likely to divorce if they had the same level of education compared to marriages where the husbands had more education.
The study appears in the August issue of the American Sociological Review.
More information
The National Women's History Museum (https://www.nwhm.org/online-exhibits/education/introduction.html ) has more on how societal views on women and education have changed over time.
SOURCE: American Sociological Association, news release, July 27, 2014
by Maureen Salamon

Don't Let Kids Drink Pool Water

Expert offers tips for spotting chlorine poisoning, bacterial infection, secondary drowning in kids
SATURDAY, July 26, 2014 (HealthDay News) -- Pools can provide much-needed relief from the summer heat, but kids can make themselves sick if they swallow too much chlorinated water, experts warn.
Amid the splashing and excitement, it's common for little ones to get water in their mouth. Some kids may even take a drink from a pool, despite warnings from their parents.
Although swallowing a small amount of pool water is harmless, it's important for parents to realize that ingesting too much can lead to chlorine poisoning or so-called recreational water illness, according to Dr. Sampson Davis, an emergency room physician at Meadowlands Hospital Medical Center in New Jersey. Kids can also inhale water into their lungs, Davis added, which can lead to a serious condition called secondary drowning.
Recreational water illnesses can also be serious. Pool water contains chlorine -- a chemical used to help get rid of bacteria such as E. coli and parasites. Chlorine may not eliminate all of these germs, so if children swallow pool water they could become sick, Davis said.
If parents and caregivers are aware of these risks, they can take steps to prevent them from happening. By being aware, parents can also recognize warning signs and seek immediate medical attention, Davis added.
To help parents protect their children, Davis advised parents to watch out for the following symptoms that could develop within a few hours or up to 72 hours after swimming:
The first signs of trouble usually include:
Upset stomach and vomiting Persistent cough Trouble breathing Fatigue
As the hours pass, recreational water illness, chlorine poisoning and secondary drowning become more distinct conditions with more specific and severe symptoms, noted Davis.
Recreational water illness and chlorine poisoning may lead to digestive distress, such as abdominal cramping and diarrhea. These conditions may seem like a bad case of food poisoning or stomach flu.
Chlorine poisoning may also cause symptoms in the nervous and respiratory systems. Children may experience trouble with their vision. Swelling and burning may also develop in their eyes, throat, nose and ears.
Secondary drowning has a greater effect on the respiratory system. Children will experience trouble breathing and have heavy, wet-sounding, persistent coughs. They will also develop uncontrollable shivering as well as hot and cold flashes.
Children who have any of these symptoms should be taken to an emergency room immediately.
Davis offered the following tips for warding off trouble:
Once a child is finished swimming, check for redness and irritation around the eyes, nose, mouth and ears. This could be a sign that chlorine levels were too high. Listen for a nagging cough. If a child who has been swimming develops a cough that does not go away, it could be a sign that the child swallowed too much water or inhaled it. Be on alert for flu-like symptoms. If a child develops symptoms of the flu or food poisoning after swimming, seek immediate medical attention.
More information
The U.S. Centers for Disease Control and Prevention has more about swimming pool safety (http://www.cdc.gov/features/dssafeswimmingpool/index.html ).
SOURCE: Meadowlands Hospital Medical Center, news release, June 30, 2014
by Maureen Salamon

Lift U.S. Ban on Blood Donations by Gay Men, Experts Say

American Red Cross, other groups also urge easing restrictions due to better blood screening
FRIDAY, July 25, 2014 (HealthDay News) -- The United States should repeal a 30-year policy that bans blood donations from gay and bisexual men, according to a team of medical and legal experts writing this week in the Journal of the American Medical Association.
Currently, a man who has ever had sex with another man cannot donate blood in the United States -- a lifetime ban that has been in place since 1983.
The U.S. Food and Drug Administration adopted this policy at the dawn of the AIDS crisis. However, changing times and technological advances have rendered the decades-old ban obsolete, said JAMA article co-author Glenn Cohen, who directs Harvard Law School's Petrie-Flom Center for Health Law Policy, Biotechnology & Bioethics.
"We think it's time for the FDA to take a serious look at its policy, because it's out of step with peer countries, it's out of step with modern medicine, it's out of step with public opinion, and we feel it may be legally problematic," said Cohen, who co-wrote the article with Jeremy Feigenbaum of Harvard Law School and Dr. Eli Adashi of Brown University's medical school.
The lifetime ban for gay or bisexual men stands in contradiction to other FDA policies regarding people considered high-risk donors due to their sexual behavior, Cohen noted.
For example, there currently is a maximum one-year ban in the United States for blood donations by men who have had sex with an HIV-positive woman or commercial sex workers. The same goes for women who have had sex with HIV-positive men.
By implementing a lifetime ban on donation from sexually active gay or bisexual males, "you're giving a 'scarlet letter' of sorts to these men," Cohen said.
The policy also stands in stark contrast to recent advances in gay rights, and could be open to a legal challenge, given that the U.S. Supreme Court struck down the Defense of Marriage Act in 2013, he said.
Other countries have already moved to limit their bans on blood donations from gay men in recent years. Canada has changed its policy to a five-year ban, there's a one-year ban in place in the United Kingdom and a six-month ban in South Africa.
None of these countries has experienced any increase in HIV-positive blood donations, noted Dr. Steven Kleinman, a senior medical advisor to the AABB, an international non-profit blood bank association.
Current technology allows accurate detection of HIV in the bloodstream within weeks of exposure, Kleinman said. Changing the ban to six months or a year remains a conservative approach that still allows officials to prevent contamination of the blood supply, he said.
"It's correct to say that countries have made changes and so far we haven't seen any adverse effects," Kleinman added.
FDA spokeswoman Jennifer Rodriguez said that the agency is open to changing the lifetime ban and is awaiting the results of new research that will provide additional evidence.
An advisory committee to the FDA in 2010 voted in favor of retaining the existing policy. But it also found that the ban might be keeping some low-risk donors from contributing to the nation's blood supply, she said.
The committee also recommended looking at the results of studies that have been undertaken by the U.S. Department of Health and Human Services (HHS). The studies are aimed at reviewing rates of transfusion-transmitted infections and investigating whether another screening strategy for gay men could maintain the safety of the nation's blood supply, the HHS said.
Officials at HHS said the results of this research should be available by the end of 2014.
"When the results and data from the studies are available and potential policy revisions are brought forward for consideration, HHS intends to provide opportunities for discussion in a public forum," Rodriguez said.
The American Red Cross and the AABB both advocate changing the U.S. policy on donations by gay men to a one-year ban -- on par with donation policies for other high-risk groups.
But Cohen wants to go further, advocating an "assess and test" approach, in which restrictions are placed on potential blood donors based on their personal sexual practices.
Italy adopted such an approach in 2001, and "Italian data suggests there's no disproportionate increase in the number of HIV-positive donors getting into the blood supply," he said.
The AABB does not support that approach at this time, although even a one-year ban amounts to a requirement that gay men abstain from sex to be eligible to donate, Kleinman said.
"We're not requiring anyone else to be abstinent from their sexual partners of choice," he said, noting that lesbians can donate freely. "But we still find that the risk factor that accounts for the greatest proportion of cases are males who have sex with other males. That's an epidemiological fact at this point."
More information
For more on the U.S. policy on blood donations from gay men, visit the U.S. Food and Drug Administration (http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/QuestionsaboutBlood/ucm108186.htm ).
SOURCES: Glenn Cohen, J.D., director, Petrie-Flom Center for Health Law Policy, Biotechnology & Bioethics, Harvard Law School, Cambridge, Mass.; Steven Kleinman, M.D., senior medical advisor, AABB; Jennifer Rodriguez, spokeswoman, U.S. Food and Drug Administration; July 23, 2014, Journal of the American Medical Association
by Maureen Salamon

Study Links Shift Work to Risk for Type 2 Diabetes

Researchers cite many possible reasons for the effect, including hormonal changes
THURSDAY, July 24, 2014 (HealthDay News) -- Shift workers, especially men, may be at higher risk for type 2 diabetes compared to people not on such schedules, a new study suggests.
Also at special risk are shift workers who don't work on a set schedule, with shifts moving around at various times of the day.
The findings are "not at all surprising," said one expert, Dr. Alan Manevitz, a clinical psychiatrist at Lenox Hill Hospital in New York City.
"Physicians have long known that working shifts disrupts many key body chemicals, creating a ripple effect that can lead to ailments such as gastrointestinal disorders, cardiovascular disease and even cancer," he said. "Now type 2 diabetes can be added to this considerable list."
In the new review, researchers analyzed data from 12 international studies involving more than 226,500 people.
The study, led by Zuxun Lu of Huazhong University of Science and Technology in Wuhan, China, took several factors into account, such as workers' shift schedules, their body mass index (BMI, a calculation of height and weight), family history of diabetes and their level of physical activity.
Although the findings weren't able to show a direct cause-and-effect relationship, the researchers found that any amount of shift work was linked to a 9 percent greater risk for developing diabetes. Gender also played a role -- for men engaged in shift work, the risk jumped to 37 percent.
Although the reason why men are at greater risk than women isn't clear, the researchers believe that testosterone levels may play a role. Prior studies have pointed to an association between low testosterone levels and insulin resistance and diabetes, the researchers noted.
Daytime levels of this male hormone are regulated by the internal body clock, Lu's team explained.
Those whose shifts moved around through different periods of the day were especially likely to develop type 2 diabetes than those who worked normal "office hours." The study found rotating shift work to be linked to a 42 percent greater risk for diabetes.
According to Lu's team, erratic working schedules make it more difficult for the body to establish a sleep-wake cycle, and poor sleep may worsen insulin resistance, a precursor to diabetes.
Previous studies have also linked shift work to weight gain and obesity, a big risk factor for type 2 diabetes. And the researchers note that shift work can also affect cholesterol levels and blood pressure.
Another expert said other factors may be at play as well.
"Growth hormone, known to elevate blood glucose when present in excess, peaks at 1 a.m.," noted Dr. Gerald Bernstein, director of the Diabetes Management Program at Friedman Diabetes Institute at the Beth Israel Medical Center in New York City. "Shift work also often makes it more difficult to schedule regular meals and exercise."
Still, Bernstein said that "even with a strong risk for diabetes I would not discourage someone from taking a job that is based on shifts."
Instead, he said "it would be better to screen shift workers regularly for pre-diabetes and intervene to slow the progression to full-blown diabetes."
Manevitz agreed. "Those who must do shift work would be wise to consult their doctor, who can monitor cholesterol levels, blood pressure and insulin levels to detect if blood sugar levels are creeping up dangerously," he said. "Doctors may also be able to prescribe sleep aids to help shift workers get the proper amount of sleep, even if that sleep comes during odd hours."
The study was published recently in Occupational & Environmental Medicine.
More information
The American Psychological Association provides more information on the health effects of shift work (http://www.apa.org/monitor/2011/01/night-work.aspx ).
SOURCE: Alan Manevitz, M.D., clinical psychiatrist, Lenox Hill Hospital, New York City; Gerald Bernstein, M.D., director, Diabetes Management Program, Friedman Diabetes Institute, Beth Israel Medical Center, New York City; Occupational & Environmental Medicine, news release, July 24, 2014
by Maureen Salamon

Human Brain Has Coping Mechanism for Dehydration

The mind preserves oxygen to protect itself from the effects of too little fluid, research shows
FRIDAY, July 25, 2014 (HealthDay News) -- The human brain can preserve oxygen to protect itself from the effects of dehydration, a new study finds.
Although dehydration significantly reduces blood flow to the brain, researchers in England have found that the brain compensates by increasing the amount of oxygen it extracts from the blood.
"This research has helped us understand a lot more about how the human brain responds to extreme exercise in extreme conditions," study first author Steven Trangmar, a researcher at Brunel University, said in a university news release. "We can now see that blood flow to this vital organ is significantly affected by dehydration. But we can also see that this is when the brain kicks in, preserving its own oxygen consumption to ensure it sustains its function."
This coping mechanism is likely what enables athletes who become dehydrated during exercise to keep going. The study authors cautioned, however, that their findings should serve as a reminder of the importance of proper hydration, noting that getting enough fluids is essential for athletes who want to maintain peak performance.
"These findings show that the brain has remarkable ways of protecting itself from extreme circumstances, however they also clearly substantiate the recommendation that people should ingest fluids during exercise to help optimize physiological function and performance," Jose Gonzalez-Alonso, a professor of exercise and cardiovascular physiology at Brunel University, said in the news release.
In conducting the study, the researchers inserted catheters in the brachial artery and internal jugular vein of 10 experienced male cyclists. Using the catheters and Doppler ultrasound technology, they measured the blood flow of the cyclists as they rode a bike to exhaustion in heat.
As they became dehydrated, the cyclists developed reduced body mass, brain blood flow and ability to exercise, as well as an increase in their internal body temperature.
The findings were published recently in the Journal of Physiology.
More information
The U.S. Centers for Disease Control and Prevention offers tips on how to prevent dehydration (http://www.cdc.gov/nutrition/everyone/basics/water.html ).
SOURCE: Brunel University, news release, July 23, 2014

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